Nursing activities and associated workload of nurses in virtual care centres: A multicentre observational study

Virtual care centres (VCCs) are novel wards of hospitals and facilitate the provision of remote monitoring and home-based patient care by virtual care nurses. Whereas since the COVID-19 pandemic VCCs have rapidly emerged, there is a lack of insight in virtual care nurses' work and the associated work load. Therefore, the aim of this study was to identify the nursing activities performed in Virtual Care Centers (VCCs) and assess nurses' perceived workload associated with these activities. A multicentre descriptive, observational cross-sectional study was performed. Data collection (February - June 2024) involved three steps: establishing a list of nursing activities, defining and quantifying workload using the NASA-Task Load Index and Analytical Hierarchy Process (AHP), and measuring nursing activity-associated workload by a survey involving 19 virtual care nurses across six VCCs in the Netherlands who had been employed in VCCs for at least one year. Eventually, we identified 21 nursing activities categorized into five areas: education and training (n = 2), development and promotion of new care pathways (n = 4), patient contact (n = 4), clinical decision-making (n = 8), and administration (n = 2). The overall workload was predominantly rated as low to medium, with the development of protocols for new digital care pathways being the most demanding activity. Routine nursing activities, such as patient contact and clinical decision-making, resulted in low to very low workload ratings. In conclusion, we found VCC nurses engage in a broad spectrum of conventional and novel nursing tasks, of which we measured their associated workload using a novel approach integrating NASA-TLX and AHP. The highest associated workload suggest the need for task differentiation and/or additional training to support nurses in managing these high-demand tasks. The VCC model may offer a viable alternative for nurses experiencing high workloads in conventional wards, potentially alleviating some pressures on nursing staff in traditional healthcare settings, mostly in the shift from physical to mental demand.